Bridge treatment for opioid withdrawal is a rarity around the country, but two healthcare systems in Rochester have begun piloting it locally.
The University of Rochester Medical Center started its program in May, and Rochester Regional Health began in July.
The two programs developed independently, but they have the same goal: bridging the gap between when patients going through withdrawal come in for help, and when they can start treatment for addiction. Traditionally, this process takes weeks, but bridge programs give patients a course of medication to quell withdrawal symptoms and set them up with an appointment to start treatment within days.
Mark Winsberg, head of chemical dependency at Rochester Regional, said research is showing the traditional approach is too slow: Unless treatment is available immediately, people seeking it are likely to use drugs again to stave off withdrawal symptoms.
“When a person has decided they’re ready to seek treatment, that’s the best time to get them the help they need,” Winsberg said. “If that person says, ‘I’m done, I need help,’ then let’s strike while the iron’s hot.”
The treatments rely on a clinician being able to prescribe buprenorphine, which is under strict federal licensing requirements as one of three medications approved to treat opioid addiction.
That limits the availability of buprenorphine, especially in emergency room settings, where doctors can give patients the medication for acute symptoms, but can’t prescribe it to keep the withdrawal at bay after patients are discharged.
The URMC pilot set up a system to page one of its 12 clinicians licensed to prescribe buprenorphine if a patient in the emergency department is interested in treatment, said Holly Russell, who is directing the program there. That physician will write a short-term prescription to bridge the gap between the patient’s discharge from the emergency room and the start of either inpatient or intensive outpatient treatment at Highland Family Medicine.
It’s an approach that Russell said seemed obvious once they started it, but was actually a significant departure from emergency room orthodoxy. “Traditionally the emergency room was a place where patients got treated for withdrawal and then discharged,” she said. “This is pretty radical, this idea of starting treatment for substance use disorders in the emergency room.”